PACS:
1. n. (acronym)Picture Archiving and Communications System. A device or group of devices and associated network components designed to store and retrieve medical images.
2. n. (acronym)Pain And Constant Suffering.

Tuesday, March 27, 2012

The Future Of Radiology? Seriously??

As you know, I do occasionally follow the internet trails that lead my readers to this information sink called DoctorDalai.com. It sends a thrill up my leg to know that anyone actually reads this drivel, and I just have to know how you may have stumbled upon this particular intellectual wasteland.

Someone from Rome (Italy, not Georgia) found me by Googling the phrase, "when radiology pacs don't work." We can only wonder which system they might be using...anyone have a GEneric Answer I can Give For thAt?

Anyway, coming before this blog on the search was an entry for RadBay, The American Radiology Exchange, LLC, "The Future of Radiology" or so they say. Now, I think this company has been discussed on AuntMinnie, but I can't find the thread, so we'll pursue this as a new topic.

What is BadRay, I mean RadBay, and what did they do to earn my sarcastic derision? Simply put, they reduce the radiology business to an auction:

RadBay is an internet based auction site that matches up hospitals, imaging centers, and physician offices (including other radiology groups in the case of night reads) with radiologists through an online bidding process.

After a radiologist has signed up and installed our PACS partner’s viewer, his/her account is activated on RadBay. Imaging centers send studies to the RadBay PACS which sends the study info to RadBay to be auctioned to qualified radiologists for competitive bidding. You can bid on single or multiple studies at once. Once a study is auctioned, the radiologist will interpret it and sign off on the report in a specified time. The time is different based on the priority (stat, ASAP, routine) of each study. Once you interpret a study, it will be transcribed by the imaging center’s transcriptionist. After you sign your report on the PACS, RadBay bills the imaging center for the interpretation. RadBay then pays you after receiving payment from the imaging center.

As for the imaging center...

After you have signed up and been connected by our PACS partner, completed studies are auctioned to qualified radiologists for competitive bidding. When you sign up, you have the option of setting a maximum price for each type of study to ensure costs are controlled. The auction process allows qualified radiologists to bid competitively to drive down the price you’ll have to pay to have your study interpreted. You can allow any qualified radiologist in your state to bid on a study or restrict bidding to your preferred or sub-specialized radiologists. RadBay only lets radiologist that are caught up on their work to bid. Once a study is auctioned, the radiologist is required to interpret it and sign off on the report in a pre-specified time. The time is different based on the priority (stat, ASAP, routine) of each study. You may use your own transcriptionist or allow us to connect you to a preferred transcription service. You are then billed by RadBay and the radiologist is paid by RadBay, thus completing the transaction. With a vast pool of radiologists and the ability to add and remove radiologist with ease, quality can be maintained to the highest standard and the fastest report turnaround can be achieved. In addition, radiologist have the opportunity to give technologist feedback on every study. You can get reports from this feedback, allowing you to see how you can improve the quality of your studies.

Why a radiologist would want to work as the low-bidder is beyond me, although I guess you gotta do what you gotta do, right? For the imaging center, the attraction is clearly spelled out by our friends at BadRay RadBay (and this is on their website, mind you...I'm not making this up!):

Summary Of RadBay Benefits

Profit
The auction process allows the hospital or imaging center to pay the lowest rate for interpretations on each study, keeping more of the global charge.

Quality

Imaging centers and hospitals can pick from a list of all licenced radiologist in their state, regardless of geographic location. If they experience problems with the reports of a radiologist, they just remove him/her from their list. There is no longstanding contract with a radiologist, politics, or privilege issues to prevent removal from the list.
Every study can be read by a radiology sub-specialist, giving even the smallest communities the level of radiology care previously only achievable at large academic centers.
Radiologists can easily give electronic feedback on every study, so radiology directors can get hard data on what can be improved in their department.
With or without a local PACS, our cloud PACS can act as a backup PACS for your facility (without additional charge).

Rapid Delivery Of Care

RadBay monitors the workload of each radiologist and does not let them bid on new work until they are caught up, insuring rapid report turnaround.

Credentialing/ Governmental

You can do your own credentialing from the information that we collect from radiologist when they sign up, or pick from a list of radiologists that are credentialed through a Joint Commission Certified process. With patient studies archived in the cloud PACS, if a patient goes to a different center or even a different state, their images are readily available, moving toward the federal government’s goal of easy access to electronic medical records.

Community

The American Radiology Exchange, LLC believes in supporting local communities and seeks to donate a portion of every dollar earned on RadBay to support local nonprofits. Imaging centers are encouraged to recommend a local non-profit for RadBay to support.

The first entry is of course the most important, of course. And why deny it?

Somehow, it isn't surprising that BadRay RadBay uses Viztek PACS, which is certainly adequate to the job, but definitely not the most expensive product out there.

This is how low we've sunk, folks. Medicine by low-bid. Would you want your scan read on this basis? Not to denigrate those fine radiologists who find themselves in need of employment by these means, but come on, folks. This is ridiculous. I'm a capitalist, and proud of it, but I have to think that medicine is somehow different than making widgets. So, what's next? Surgery by the lowest bidder?

As you admit yourself, and what anyone who have come across your blog before knows, you are a staunch defender of the free market and capitalism. The most basic part of *that* is a well-functioning market where the price of goods and services are determined by supply and demand.

I thought this was a joke, Dr. Dalai, but it appears that the internet has now ruined yet another profession, having visited the RadBay website. I feel that us radiologists are fast becoming glorified x-ray reading machines and will soon be traded on the commodities markets! This will probably appeal to GP's doing bad x-rays in their offices and charging big bucks, but it might prove to be a real privileging nightmare for hospitals and an absolute quandary for malpractice insurance companies. Moreover, I can't imagine the infinite possibilities for HIPAA violations and identity theft, and I wonder if this kind of arrangement is even legal or Medicare kosher. Start lobbying your congressman now to have this arrangement outlawed!